Healthcare Provider Details

I. General information

NPI: 1417164039
Provider Name (Legal Business Name): GLENN ROBERT RINGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 CHESTNUT RIDGE DR
WINDERMERE FL
34786-8945
US

IV. Provider business mailing address

9725 CHESTNUT RIDGE DR
WINDERMERE FL
34786-8945
US

V. Phone/Fax

Practice location:
  • Phone: 407-909-1506
  • Fax: 407-000-0000
Mailing address:
  • Phone: 407-909-1506
  • Fax: 407-000-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME84850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: